Supervised group exercise has been shown to be an effective component for improving balance and preventing falls among elders who have suffered falls or exhibit a fear of falling due to frailty. In a Phase I SBIR study, we developed a model for conducting group exercise programs for elders in their homes via video- conferencing, called tele-based group exercise (tele-ex), using a modified, commercial, off-the-shelf videoconferencing device attached to an elder's home television. The tele-ex allowed elders to participate in supervised group exercise classes from their homes, while allowing real-time, two-way instruction, participation, and supervision by an exercise instructor who could simultaneously observe all of the participants in the class. The goals of this SBIR Phase II application are to further refine the video-conferencing device, and to further evaluate the adherence, effectiveness, and quality and satisfaction of the tele-ex program as compared to traditional community-based group exercise (comm-ex) and home-based individual exercise (home-ex) programs. The target population is community-dwelling elders who are at risk for falls. Specific aims for Phase II include: 1. Develop a purpose-built videoconferencing unit for use in the elder's home, with the view of commercialization of the videoconferencing unit, and a service for delivering facilitated home-based exercise programs. 2. Evaluate the adherence to and effectiveness of the tele-exercise program among community-dwelling, fall- risk elders, as compared to comm-ex and home-ex programs. 3. Evaluate the quality of tele-communication and the level of satisfaction of tele-ex technology by community- dwelling elders. We will conduct a randomized controlled trial, involving three groups (a tele-ex group, a comm-ex group, and a home-ex group), each with a 15-week Tai Chi exercise program, and pre- and post-exercise tests. We will test a total of 72 subjects, 24 in each group. We hypothesize that 1) compared to elders in both comm-ex and home-ex groups, elders in the tele-ex group will have a higher exercise adherence rate; and 2) compared to elders in the home-ex group, elders in the tele-ex group will have decreased fear of falling, increased balance and quality of life post exercise. The study aims specifically at one major cause of disability in the elderly population in the U.S: unintentional falls. Participation in regular exercises, such as Tai Chi, has been shown to reduce the risk of falls and fear of falling. With a majority of elders being physically inactive, interactive and supervised exercise programs delivered via videoconferencing to elders' own home television present an attractive way to engage them in regular exercises, leading to improved balance, reduced risk of falls and fall injuries, and independence. [unreadable] [unreadable] [unreadable]